Recovering from Multiple Sclerosis with dietary and lifestyle changes

Dr Sam Gartland is a GP based in Ballina NSW. In 2008 he was diagnosed with relapsing-remitting MS. Through evidence-based lifestyle changes, including a whole food plant-based diet, Sam has achieved a full recovery, and is now an active advocate for these approaches to be at the centre of MS patient care. On World MS Day, Sam shares the empowering science behind his own recovery and explains why more dietary studies should be a priority in MS research.

The 2020-2022 World MS Day theme is ‘connections’. MS Connections is all about building community connection, self-connection and connections to quality care.

What is Multiple Sclerosis?

MS is considered to be an autoimmune, degenerative and progressive disease of the central nervous system (brain and spinal cord). The resulting symptoms can manifest throughout the body, including motor impairments from weakness and spasms to paraplegia, optic neuritis, bladder and bowel dysfunction, as well as intense fatigue and cognitive decline over time.

Healthy versus damaged nerve myelin

MS is the commonest disabling disease of young adults affecting 25,607 people in Australia – an increase of around 20% between 2010-2017. [1]


It is a devastating disease with a large number (up to 58%) unable to retain employment following diagnosis [2] and 75% ceasing work within 10 years of diagnosis. [3]



Nurture before nature

Studies of identical twins have demonstrated that genes contribute 25% to the risk of developing MS. [4] The stronger the genetic background risk the earlier the onset of MS. [5] Of importance to PwMS (People with MS) and their treating doctors is the finding that genetics has little role to play in disease progression and outcomes in MS.

  • The largest genetic study of PwMS, The International MS Genetics Consortium study, looked at the genome of 9772 PwMS and found, “no evidence for genetic associations with clinical course, severity of disease or month of birth, and no evidence of interaction with gender…”[6]

  • The largest meta-analysis of established MS genetic risk variants and disease severity found no effect of genes on clinical outcomes over the longer term (10 + years).[7]

  • A smaller (n=127) study did show an up to 30% effect of genes on disease progression in the first 5 years of the disease.[8]

It is clear that environmental and lifestyle factors are the main drivers of MS.

It is clear that environmental and lifestyle factors are the main drivers of MS. Fortunately there is a lot known about these risk factors. The known environmental and lifestyle factors include: 

  • A Western diet high in saturated fats and low in Omega 3s [9, 10]

  • Cow’s milk exposure [11, 12]

  • Viral infections (EBV, HHV) [13]

  • Low Vitamin D and sunlight exposure [14, 15]

  • Smoking [16, 17, 18]

  • Stress [19, 20, 21, 22]

  • Shift work [23, 24, 25]

Therefore, just as with other modern chronic conditions, any comprehensive treatment program has to address these modifiable risk factors.

3D illustration of nerve cells

The lifestyle prescription

In 1948 the Neurologist Prof Roy Swank recognised the association between animal fat consumption and the incidence of MS. This prompted him to set up a remarkable 34 year study that investigated the effect of a low saturated fat diet in MS. Publishing his work in The Lancet in 1990 he demonstrated that those that adhered to this diet (regardless of disability at the beginning of this study) stabilised the disease with little or no progression of disability and survived for the duration of the study. Those that didn’t keep to the dietary changes significantly deteriorated with the majority being dead at the end of the study.[26, 27]


Little was made of this study until the work of Professor George Jelinek, a Professor in Emergency Medicine. He developed MS himself and went back through the literature to develop a comprehensive lifestyle intervention program to manage MS.  In 1999 he developed the “Overcoming MS Program” (OMS).[28]


This approach advocates:

  • Adopting a plant-based diet that avoids dairy and altered fats (allowing seafood if desired)

  • Supplementing with flaxseed

  • Maintaining a Vitamin D level at 150-225nmol/L

  • Meditation

  • Regular exercise

  • Smoking cessation

Those following this program demonstrate significant improvements within 1 year: improved mental health 12%, physical health 19%, and overall quality of life 11%. [29] These changes are sustained and increase over a 5-year period with improvements in: mental health 23%, physical health 18%, and quality of life 20%.[30]


Since this time there has been an abundance of data supporting the steps that Professor Jelinek has advocated. For example, the HOLISM study surveyed over 2500 PwMS in 57 countries and found that those following the steps of the OMS program had better health outcomes: Less disability, fewer relapses [31], better quality of life [32], and less incidence of depression [33] and fatigue. [34]


Exercise has also been well documented to improve quality of life and function [35] and immunological markers in PwMS. [36] A new RCT showed that resistance training can have a neuro-regenerative effect with increases in cortical thickness. [37]

The tertiary prevention of MS must include comprehensive lifestyle changes to optimise outcomes – Dr Sam Gartland

The nutrition connection

While more dietary studies are needed, the existing evidence has shown a consistent link between saturated animal fat intake and MS. [38-43] Observational studies have additionally found that PwMS had lower antioxidant blood levels than people without MS, indicating that eating a plant-based diet high in antioxidants may also be protective against MS. [44]


So far, there has been one pilot RCT of a plant-based diet in PwMS that ran for 1 year. This did not demonstrate significant improvements on disease activity or MRI, which aligns with Swank’s findings that it takes up to 5 years to achieve disease stability. However, patients in the pilot did experience improvements in fatigue, BMI and metabolic biomarkers, which represents a significant improvement in quality of life. [45]


Further long-term RCTs are needed to develop our understanding of the diet/MS connection, but what we know so far strongly indicates that whole food plant-based diets are effective for both prevention and mitigation of MS.


Having experienced my own recovery journey, I am committed to advocating for healthy diet and lifestyle: this includes updating medical training and putting lifestyle and diet research at the forefront of MS research.

Healthy diet and lifestyle must be at the forefront of our approach to preventing and treating MS, with whole food plant-based nutrition as a central pillar

The take-home message

The understanding of the causes and (non-drug) treatment interventions for MS has increased greatly. PwMS and their treating health professionals now have a large and congruent evidence base on which to plan their treatment. The tertiary prevention of MS must include comprehensive lifestyle changes to optimise outcomes. This has finally been recognised by Neurologists. The January 2018 editorial of the Journal Neurology declared:


“encouraging a healthy lifestyle (healthy eating, a normal weight, routine physical activity or exercise, and avoiding smoking) should be a fundamental message we give to all newly diagnosed patients with MS.”[46]

Useful Links

References

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  2. van der Hiele K, van Gorp D, Ruimschotel R, Kamminga N, Visser L, Middelkoop H. Work Participation and Executive Abilities in Patients with Relapsing-Remitting Multiple Sclerosis. PloS one 2015; 10(6): e0129228-e.

  3. Coyne KS, Boscoe AN, Currie BM, Landrian AS, Wandstrat TL. Understanding Drivers of Employment Changes in a Multiple Sclerosis Population. Int J MS Care 2015; 17(5): 245-52.

  4. Parnell GP, Booth DR. The Multiple Sclerosis (MS) Genetic Risk Factors Indicate both Acquired and Innate Immune Cell Subsets Contribute to MS Pathogenesis and Identify Novel Therapeutic Opportunities. Front Immunol 2017; 8: 425-.

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  6. Sawcer S, Hellenthal G, Pirinen M, et al. Genetic risk and a primary role for cell-mediated immune mechanisms in multiple sclerosis. Nature 2011; 476(7359): 214-9

  7. George MF, Briggs FB, Shao X, et al. Multiple sclerosis risk loci and disease severity in 7,125 individuals from 10 studies. Neurol Genet 2016; 2(4): e87.

  8. Pan G, Simpson S, Jr., van der Mei I, et al. Role of genetic susceptibility variants in predicting clinical course in multiple sclerosis: a cohort study. Journal of neurology, neurosurgery, and psychiatry 2016; 87(11): 1204-11.

  9. Riccio P, Rossano R. Nutrition facts in multiple sclerosis. ASN Neuro 2015; 7(1).

  10. Hoare S, Lithander F, van der Mei I, Ponsonby AL, Lucas R. Higher intake of omega-3 polyunsaturated fatty acids is associated with a decreased risk of a first clinical diagnosis of central nervous system demyelination: Results from the Ausimmune Study. Multiple sclerosis (Houndmills, Basingstoke, England) 2016; 22(7): 884-92.

  11. Malosse D, Perron H, Sasco A, Seigneurin JM. Correlation between milk and dairy product consumption and multiple sclerosis prevalence: a worldwide study. Neuroepidemiology 1992; 11(4-6): 304-12.

  12. Winer S, Astsaturov I, Cheung RK, et al. T cells of multiple sclerosis patients target a common environmental peptide that causes encephalitis in mice. J Immunol 2001; 166(7): 4751-6.

  13. Virtanen JO, Jacobson S. Viruses and multiple sclerosis. CNS & neurological disorders drug targets 2012; 11(5): 528-44.

  14. Tremlett H, Zhu F, Ascherio A, Munger KL. Sun exposure over the life course and associations with multiple sclerosis. Neurology 2018; 90(14): e1191-e9.

  15. Derakhshandi H, Etemadifar M, Feizi A, et al. Preventive effect of vitamin D3 supplementation on conversion of optic neuritis to clinically definite multiple sclerosis: a double blind, randomized, placebo-controlled pilot clinical trial. Acta Neurol Belg 2013; 113(3): 257-63.

  16. Rosso M, Chitnis T. Association Between Cigarette Smoking and Multiple Sclerosis: A Review. JAMA Neurol 2019.

  17. Poorolajal J, Bahrami M, Karami M, Hooshmand E. Effect of smoking on multiple sclerosis: a meta-analysis. Journal of Public Health 2016; 39(2): 312-20.

  18. Hedström AK, Hillert J, Olsson T, Alfredsson L. Smoking and multiple sclerosis susceptibility. European Journal of Epidemiology 2013; 28(11): 867-74.

  19. Mohr DC, Hart SL, Julian L, Cox D, Pelletier D. Association between stressful life events and exacerbation in multiple sclerosis: a meta-analysis. BMJ (Clinical research ed) 2004; 328(7442): 731.

  20. Burns MN, Nawacki E, Kwasny MJ, Pelletier D, Mohr DC. Do positive or negative stressful events predict the development of new brain lesions in people with multiple sclerosis? Psychol Med 2014; 44(2): 349-59.

  21. Simpson R, Booth J, Lawrence M, Byrne S, Mair F, Mercer S. Mindfulness based interventions in multiple sclerosis – a systematic review. BMC Neurology 2014; 14: 15.

  22. Mohr DC, Lovera J, Brown T, et al. A randomized trial of stress management for the prevention of new brain lesions in MS. Neurology 2012; 79(5): 412-9.

  23. Hedström AK, Åkerstedt T, Hillert J, Olsson T, Alfredsson L. Shift work at young age is associated with increased risk for multiple sclerosis. Ann Neurol 2011; 70(5): 733-41.

  24. Papantoniou K, Massa J, Devore E, et al. Rotating night shift work and risk of multiple sclerosis in the Nurses' Health Studies. Occup Environ Med 2019; 76(10): 733-8.

  25. Gustavsen S, Søndergaard HB, Oturai DB, et al. Shift work at young age is associated with increased risk of multiple sclerosis in a Danish population. Mult Scler Relat Disord 2016; 9: 104-9.

  26. Swank RL, Dugan BB. Effect of low saturated fat diet in early and late cases of multiple sclerosis. Lancet 1990; 336(8706): 37-9.

  27. Swank RL. Multiple sclerosis: fat-oil relationship. Nutrition 1991; 7(5): 368-76.

  28. overcomingms.org

  29. Li MP, Jelinek GA, Weiland TJ, Mackinlay CA, Dye S, Gawler I. Effect of a residential retreat promoting lifestyle modifications on health-related quality of life in people with multiple sclerosis. Qual Prim Care 2010; 18(6): 379-89.

  30. Hadgkiss EJ, Jelinek GA, Weiland TJ, et al. Health-related quality of life outcomes at 1 and 5 years after a residential retreat promoting lifestyle modification for people with multiple sclerosis. Neurological Sciences 2013; 34(2): 187-95.

  31. Jelinek GA, De Livera AM, Marck CH, et al. Associations of Lifestyle, Medication, and Socio-Demographic Factors with Disability in People with Multiple Sclerosis: An International Cross-Sectional Study. PloS One 2016; 11(8): e0161701.

  32. Jelinek GA, De Livera AM, Marck CH, et al. Lifestyle, medication and socio-demographic determinants of mental and physical health-related quality of life in people with multiple sclerosis. BMC Neurology 2016; 16(1): 235.

  33. Taylor KL, Hadgkiss EJ, Jelinek GA, et al. Lifestyle factors, demographics and medications associated with depression risk in an international sample of people with multiple sclerosis. BMC Psychiatry 2014; 14(1): 327.

  34. Weiland TJ, Jelinek GA, Marck CH, et al. Clinically Significant Fatigue: Prevalence and Associated Factors in an International Sample of Adults with Multiple Sclerosis Recruited via the Internet. PloS one 2015; 10(2): e0115541.

  35. Bansi J, Bloch W, Gamper U, Riedel S, Kesselring J. Endurance training in MS: short-term immune responses and their relation to cardiorespiratory fitness, health-related quality of life, and fatigue. J Neurol 2013; 260(12): 2993-3001.

  36. Deckx N, Wens I, Nuyts AH, et al. 12 Weeks of Combined Endurance and Resistance Training Reduces Innate Markers of Inflammation in a Randomized Controlled Clinical Trial in Patients with Multiple Sclerosis. Mediators Inflamm 2016; 2016: 6789276.

  37. Kjolhede T, Siemonsen S, Wenzel D, et al. Can resistance training impact MRI outcomes in relapsing-remitting multiple sclerosis? Multiple sclerosis (Houndmills, Basingstoke, England) 2018; 24(10): 1356-65.

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About the author


Dr Sam Gartland is a GP based at The Clinic, East Ballina. He was diagnosed with relapsing-remitting MS in 2008. In January 2009 he attended an Overcoming MS program run by Professor George Jelinek at the Gawler foundation. By following this program he managed to return to work full time and has remained relapse free. The lesions on his MRI scan resolved and he now feels in the best shape of his life. His recovery is in line with the published results of the OMS program. His story and others can be found in the book, Recovering from MS - real life stories of hope and inspiration. Sam has been involved with Doctors For Nutrition since attending the inaugural Nutrition in Healthcare Conference in 2019. His website drsamgartland.com will be launching soon.

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